May 23, 2011

If a state Medicaid program is not in compliance with federal law and regulations, federal officials can take corrective action, including “the total or partial withholding” of federal Medicaid money...

Administration officials said the Indiana law imposed impermissible restrictions on the freedom of Medicaid recipients to choose health care providers.

Indiana is one of at least a half-dozen states that have taken aim at Planned Parenthood because it performs abortions, about one-fourth of those performed in the United States.

But we heard over and over, as the Democrats pushed health care reform, that federal law prohibits funding abortion. How then could Indiana's attempt to withdraw funding abortion violate federal law? How could federal law require states to fund abortion?

Asked for comment on the Indiana law, the federal Centers for Medicare and Medicaid Services provided this statement, cleared by the White House: “Federal law prohibits federal Medicaid dollars from being spent on abortion services. Medicaid does not allow states to stop beneficiaries from getting care they need — like cancer screenings and preventive care — because their provider offers certain other services. We are reviewing this particular situation and situations in other states.”

Medicaid is financed jointly by the federal government and the states, which must comply with federal law as a condition of getting federal money.

So a key point seems to be that Planned Parenthood offers plenty of services other than abortion, and Indiana's law isn't limited to withholding funds for abortion.

It seems unavoidable that abortion will be a central issue in the 2012 presidential campaign. Perhaps this is the real reason Mitch Daniels is avoiding running. He wanted "a truce the so-called social issues," but his signature is on that Indiana law, and he would have to defend it over and over again.

If abortion really does become a central issue in the 2012 campaign, can we finally dump the silly connection of that to gay marriage and so-called "social conservative" issues? The issues at play are completely, absurdly different.

I'm always suspicious when one side of a fight cries foul over a situation that its own conduct is responsible for creating. Planned Parenthood says that Indiana is depriving women of vital health services, but Planned Parenthood is every bit as capable of preventing that outcome as is Indiana: They are only affected by the law because they choose to offer abortion as a service. If Planned Parenthood was really concerned about the plight of poor women, they could do something about it: nothing prevents them from continuing to offer the care they claim to be concerned about, but they must choose between providing that care and providing abortion. It is vividly apparent that Planed Parenthood cares far less about the health of poor women, as they claim, than they do about abortion.

What's more, Indiana has only had to take this step because Planned Parenthood and its fellow-travelers have left this as the only avenue by which the state may do something about abortion. If the state passed a law mandating that abortions be provided only in hospitals, Planned Parenthood would litigate that, as they are doing in Virginia, IIRC.

t-man said..."This is not the reason Daniels dropped out of the race, his wife's leaving him, destroying another marriage, and then returning to him is the reason. No one would have wanted her as First Lady."

Not so. Because the Church doesn't recognize divorce, she encourages reconciliation between separated spouses. The Daniels' story is actually very attractive to Catholic voters, and while protestant denominations have a somewhat different focus, it's hard to imagine them finding the story anything but touching. I suspect the main reason Daniels dropped out is the one mentioned at Commentary this morning: Who wants to sign up to have a billion dollars worth of Obama slime poured out on you? I don't know who the GOP nominee will be, but I can guarantee that by the end of the campaign, they will have been slimed, hosed down, and beaten to a bloody pulp by the O propaganda machine. I pity the poor bastard who has to take that flak.

"The same people who were pushing McCain on us were pushing Daniels, for the same reason - he would have been beaten easily."

Horse hockey. We want to win. You want to fight in a blaze of glory, no matter the outcome. Who's really serving the conservative agenda here? It ain't you, pal.

Scott, I'm suggesting that Planned Parenthood resists any attempt by the state to regulate abortion on principle, and a fortiori those regulations that would threaten their ability to offer abortion, because then the threat to their principles is multiplied by the threat to their bottom line.

This is a rather dumb move by Obama. Let planned parenthood or private individuals litigate this. Planned Parenthood will blow up in his face. A majority of people think abortion should be legal, but that's it. Obama will not be able to convince non-believers that this is about women's health, not publicly funded abortions. PP's response that only 3 percent of our services are abortions inevitably leads to enough people saying "then you should have no problem not performing them if you want our tax dollars.". Look for a shrewd candidate to offer to quadruple PP' s federal funding if it foregoes abortions.

Obama has no economic arguments, very little foreign policy and C-in-C arguments to support his reelection. His administration's stances on Arizona's efforts at combatting illegal immigration and this balls to the wall defense of PP are putting him to the far left of the American electorate. It's like he wants to lose reelection.

"Cancer screening" seems like a fluffer of a term. I think they do pap smears and manual breast exams. They don't do mammograms.It's great they do the pap smears, but I am certain that just as men find places to do cancer screenings, women could, too.

PP, whom I actually do like, has created quite a lore for itself considering the very limited services they provide.

Most of Planned Parenthood's services, except for birth control info, are abortion.

This is about the Administration sewing up the Demo constituencies ahead of the election, not unlike the NLRB going after Boeing.

Scott M said...

If the state passed a law mandating that abortions be provided only in hospitals, Planned Parenthood would litigate that, as they are doing in Virginia, IIRC.

Tut-tut. Are you suggesting that PP can't carry out Sanger's original intent if it's left up to the hospitals?

The death panels aren't set up to do actual death.

Yet.

So if you do something evil that we don't fund, you can get funding anyway as long as you also do something good?

Is that like the Nazis building the autobahn?

(too soon?)

Well, if you consider being able to redeploy your Panzer divisions from Poland to France that much quicker a good thing.

Simon said...

t-man said..."This is not the reason Daniels dropped out of the race, his wife's leaving him, destroying another marriage, and then returning to him is the reason. No one would have wanted her as First Lady."

Not so. Because the Church doesn't recognize divorce, she encourages reconciliation between separated spouses. The Daniels' story is actually very attractive to Catholic voters, and while protestant denominations have a somewhat different focus, it's hard to imagine them finding the story anything but touching.

Only for the Andrew Greeley Catholics. Most, I think, are going to see it t-man's way.

"Only for the Andrew Greeley Catholics. Most, I think, are going to see it t-man's way."

Andrew Greeley is a vile little heretic with only the most tenuous connection to the Church. And ironically, you in fact have it precisely backwards: it is the Greeley Catholics (if there is such a thing; "lapsed Catholics" would suffice) who dissent from the Church's teaching about marriage, and who are by-and-large Democrats, who are likely to see it t-man's way. Faithful, orthodox Catholics will not. Because we recognize that marriage can't be undone by man, see Mt 5:31 et seq.; Mal 2:16; CCC ¶ 1649 (in "situations in which living together becomes practically impossible," "the Church permits the physical separation of the couple," but "[t]he spouses do not cease to be husband and wife before God and so are not free to contract a new union. In this difficult situation, the best solution would be, if possible, reconciliation"), we appreciate the reconciliation of formerly separated spouses.

Instead of abortions why doesn’t PP just tie up tubes? I know that it will impact the long term bottom line but it gets them out of the whole ‘abortion’ issue. Yes I hear the counter already, “But that would eliminate a woman’s opportunity of choice!”

But wouldn’t a woman have more: 1) opportunity (less down time because of getting an abortion), 2) freedom from consequences (getting pregnant), and 3) choice (can get with more guys [or more with one guy]) since 1) and 2) are covered? Just sayin…

Doesn't the state have the authority to certify a provider as a provider of Medicaid services? Are the Feds usurping authority from the state.

Here's a hypothetical:-Physician in inner city Houston is found to practice substandard medicine. State medicaid program rescinds his credentials to care for Medicaid patients. Unfortunately physician has powerful connections in Washington. Through various channels, feds "encourage" state to reinstate this physician's Medicaid credentials.

If the Indiana challenge is successful, would it make this scenario possible?

I live in Northern Indiana-- several times a year, local organizations offer FREE pap smears and mammograms. Some of the hospitals even have pap smear/ mammogram vans that go to low-income areas, set up in a high traffic area (schools at pick-up/drop off time, for example) and do cancer screenings.

Obama is full of BS. Even college girls don't go to PP for pap smears-- they go to the student health center.

Is PP the ONLY source for cancer screenings, etc. in the whole entire state?

DING, DING, DING, DING!!!

Exactly.

On the private insurance side occasionally an employer group will insist that provider X be in the network (can be a variety for reasons). I'd say this is similar to what the administration is trying to do with Indiana Medicaid (especially since they too have the $$) but it goes to a deeper question:

who has the final say in what's best for Indiana citizens, the state government of Indiana or the Federal government in Washington?

I'd also wonder if anyone in the administration thought about how this action might impact on the whole state mandate discussion within Obamacare.

Right now you have to pay for the full range of "autism services" in Colorado, due to state legislative mandate. If successful, could this effort be used to establish precedent for "ignoring" suchstate legislative mandates?

It seems unavoidable that abortion will be a central issue in the 2012 presidential campaign.Abortion? Or funding/defunding PP?

Planned Parenthood says that Indiana is depriving women of vital health services, but Planned Parenthood is every bit as capable of preventing that outcome as is Indiana: They are only affected by the law because they choose to offer abortion as a service. I'd argue that PP is affected by the law because they take money from the govt. If they really wanted to keep the laws off their business, they would privatize. Seems pretty simple to me.

Ponies are legal, but that doesn't mean the govt is obligated to buy me one.

I suspect the main reason Daniels dropped out is the one mentioned at Commentary this morning: Who wants to sign up to have a billion dollars worth of Obama slime poured out on you?

There have been some Daniels supporters who, in attempting to promote him, have repeatedly and gratuitously slammed Sarah Palin as a "quitter." Slamming Palin as "the quitter" when she has been slimed more than anyone in recent political memory and yet she continues to fight on.

The real reason that Daniels quit is because HE is the quitter. To be sure, he is a pre-emptive quitter. He based a large part of his "I'm the adult here" argument on his willingness to give up and not bother to fight on a whole host of issues. The real reason that Daniels called a truce on any campaign is because he advocates calling truces.

It is not because he is too smart, it is not because he is too nice, it is not because he's the adult, it is not because he is short and bald, it is because he has no spine. He is a capitulator who wants to pre-emptively surrender.

Blogger is playing hokey-pokey with comments. And, this one posted on another thread.

Oh, please.

Jimmy Breslin, so unhappy with the stories of pedophilia in his beloved church ... says that what's left of the priesthood, sermonizes about abortion. (To all the old ladies past menopause.) And, he added: IF 10% of those parishioners care, he'd be amazed.

Politicians and priests talk about abortions all of the time. Doesn't amount to a hill of beans.

Too bad the GOP is riddled with the label that they house religious zealots.

Abortion is a "profit center" for PP without any federal funding, and those surplus funds generated offset the LOSSES that PP generates providing services under Medicaid. Medicaid is not subsidizing abortion. It's the other way around.

All witholding Medicaid funds from PP will accomplish is to reduce the availability of those other services. As much as it pains me to say so, the administration is absolutely correct here.

Joanna said..."Ponies are legal, but that doesn't mean the govt is obligated to buy me one."

Right, which is the gist of Harris v. McRae. Under current doctrine, the government can't ban abortion, but it's under no obligation to help anyone have access to it. In that regard, it's like every other constitutional right except that to counsel.

Abortion is a "profit center" for PP without any federal funding, and those surplus funds generated offset the LOSSES that PP generates providing services under Medicaid. Medicaid is not subsidizing abortion. It's the other way around.

Tully said..."All witholding Medicaid funds from PP will accomplish is to reduce the availability of those other services."

For many of us, Government should not be funding a grave moral evil, or a provider of grave moral evil, and so a law that terminates the government's giving money to an abortion provider is an accomplishment. Your error here is to presuppose your definition of accomplishment to others who may not (and don't) agree with it in evaluating whether a measure is a success. Simply put, you don't get to decide what is and isn't a valid accomplishment.

I find this ironic because when I was on Medicaid in Indiana less than 10 years ago the OBs decided to protest whet they saw as inadequate reimbursement and they all stopped seeing Medicaid patients. There was one OB in a three county area that took Medicaid. Now in Indiana family practice docs will deliver babies and they rather unhappily picked up the slack but if you were high risk and on Medicaid you had to hope that one OB would take you. Yet, the federal government didn't seem so concerned about denial of a much more common service then!

TMink said..."So a key point seems to be that Planned Parenthood offers plenty of services other than abortion"

That is not accurate. Over 90% of direct services offered by PP are abortions.

Based on what math? According to this—written after Sen. Kyl made the same claim—abortions constitute less than three percent of the total services performed (332,278 procedures of 11,383,900 total services). Does it look differently if we consider these in terms of money? What's a source for that?

Simon: "Which. PP is an it not a who, and the clause is non-defining, so between who/which/that, which is the right pronoun. The "do" is superfluous, too: "PP, which I actually like..." has the same meaning."

"So a key point seems to be that Planned Parenthood offers plenty of services other than abortion"

That is not accurate. Over 90% of direct services offered by PP are abortions.

The problem here (and I'll defer to Tully if he has better details) is that PP doesn't report services the way other provider/physician offices do. The list "services" as in CPT codes. I can go to the doc for a check up and get a mole removed. That could end up as 10 services but only one visit...

And also listed as one surgery.

Tully, to follow up on your cost shifting theory, I'd also posit that PP shifts federal dollars for "education" to its clinical functions.

Governor Mitch Daniels issued this statement about the Indiana legislation:

“I will sign HEA 1210 when it reaches my desk a week or so from now. I supported this bill from the outset, and the recent addition of language guarding against the spending of tax dollars to support abortions creates no reason to alter my position. The principle involved commands the support of an overwhelming majority of Hoosiers, as reflected in greater than 2:1 bipartisan votes in both legislative chambers."

“I commissioned a careful review of access to services across the state and can confirm that all non-abortion services, whether family planning or basic women’s health, will remain readily available in every one of our 92 counties. In addition, I have ordered the Family and Social Services Administration to see that Medicaid recipients receive prompt notice of nearby care options. We will take any actions necessary to ensure that vital medical care is, if anything, more widely available than before."

“Any organization affected by this provision can resume receiving taxpayer dollars immediately by ceasing or separating its operations that perform abortions.”

More about the impact of HEA 1210 in Indiana:· This law will affect 7 entities in Indiana which have a total of 34 locations in 21 counties throughout the state.

· In the 21 counties where these 7 entities currently operate, there are approximately 800 Medicaid providers which are eligible to provide Medicaid clients with health and family planning services.